Secondary angle-closure glaucoma due to posterior ...

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Nov 29, 2011 - synechia of the iris after combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation. Jpn J. Ophthalmol 45:276– ...
Int Ophthalmol (2011) 31:481–482 DOI 10.1007/s10792-011-9475-3

CASE REPORT

Secondary angle-closure glaucoma due to posterior synechiae formation following phacovitrectomy Osama Makhzoum • Niall James Crosby Mark Hero



Received: 28 March 2011 / Accepted: 24 October 2011 / Published online: 29 November 2011 Ó Springer Science+Business Media B.V. 2011

Abstract Iris posterior synechiae formation after phacovitrectomy is usually regarded as a trivial problem. We report a case of secondary angle-closure glaucoma due to 360°PS 5 years after a phacovitrectomy for recurrent vitreous haemorrhage secondary to diabetic retinopathy. To our knowledge this is the first such reported case of this potentially sight-threatening complication of phacovitrectomy. We discuss our successful management of our patient, as well as potential risk factors and preventative measures. Keywords Phacovitrectomy  Glaucoma  Angle-closure  Posterior synechiae  YAG peripheral iridotomy

Introduction Combining phacoemulsification and intraocular lens implantation with pars plana vitrectomy eliminates the O. Makhzoum  N. J. Crosby  M. Hero University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK N. J. Crosby (&) Birmingham and Midland Eye Centre, Dudley Road, Birmingham B18 7QH, UK e-mail: [email protected]

need for cataract extraction as a secondary procedure. However, iris posterior synechiae (PS) formation after phacovitrectomy has been reported to occur in 7–31% of cases [1–4]. This complication is often regarded as trivial and only a problem insofar as the PS prevents dilation and an adequate view of the peripheral retina. We report a case of secondary angle-closure glaucoma due to 360° PS 5 years after a phacovitrectomy for recurrent vitreous haemorrhage secondary to diabetic retinopathy. The patient presented with a 3 day history of pain and blurred vision in his right eye. On examination his best-corrected vision was 6/9 in the right eye, 6/6 in the left. Slit-lamp examination revealed an injected conjunctiva, mildly oedematous cornea, and a mid-dilated fixed pupil with 360° of PS causing iris bombe´, a shallow anterior chamber (AC) and angle-closure with an intraocular pressure (IOP) of 46 mmHg. Synechialysis with an intensive course of topical mydriatics was unsuccessful. The patient underwent YAG laser iridotomy, resulting in immediate deepening of the AC and reduction of the IOP. He maintained a normal IOP without medical treatment. Posterior synechiae formation is a known complication of phacovitrectomy [1–4]. However, to our knowledge this is the first reported case of secondary angle-closure glaucoma as a result of PS formation post-phacovitrectomy. We would like to draw attention to this potentially sight-threatening complication and discuss possible options for prevention and management.

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The patient had a deep AC and a wide open angle before the phacovitrectomy and there were no preoperative PS. There was also no history of uveitis which could have otherwise explained the formation of the PS. He did exhibit inflammatory membrane formation, proliferative diabetic retinopathy and previous photocoagulation. These have been shown to be risk factors for the formation of PS post-phacovitrectomy [2, 5]. In order to reduce the risk of PS formation in the presence of these risk factors we suggest increasing the frequency of steroid drops in the first 4 weeks following surgery. We would also advise the use of short-acting mydriatic drops to maintain a mobile pupil, as advocated by Lee et al. [6]. For high-risk patients who appear to be progressing to 360° PS despite intensive medical mydriasis we would advocate a prophylactic peripheral iridotomy. Conflict of Interest

None to declare.

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